The Science Journal of the American Association for Respiratory Care

2005 OPEN FORUM Abstracts

Impact of Changing a Respiratory Therapy Medication Delivery System

Douglas K. Orens, M.B.A., R.R.T, Edward Hoisington, R.R.T., Lucy Kester, M.B.A., R.R.T., F.A.A.R.C., James K. Stoller, M.D., M.S., F.A.A.R.C., The Cleveland Clinic Foundation, Cleveland, OH

Background The recent focus on medication management and patient safety by the Joint Commission on Accreditation of Healthcare Organization (JCAHO) has prompted reforms in the process of delivering respiratory medications to hospitalized patients. Specifically, many respiratory therapy departments have recently changed their practice of inpatient medication delivery to comply with current standards, which require that all respiratory medications are reviewed by a pharmacist for possible drug interactions before administration, that medications are patient-specific, and, at the Cleveland Clinic Foundation, that medications are stored in a secure area. Revamping the process of respiratory medication delivery has offered the opportunity to develop strategies to optimize the efficiency of medication delivery. In the context of our goal to optimize this efficiency, the current report compares 2 strategies of delivering respiratory medication: one in which medications are stored in a central locked cabinet on each ward using a Pyxis system (Cardinal Health, San Diego, CA)(the "central approach") and another in which respiratory medications are kept in locked boxes at the patient's bedside (the "bedside approach"). The main outcomes measures for the comparison therapists' travel time and the associated labor costs.

MethodsThe "central strategy" was based on the use of Pyxis medication stations that were in use on each ward at the Cleveland Clinic Foundation Hospital. Once reviewed and verified by the pharmacy, each respiratory medication (e.g., metered dose inhalers, etc.) is delivered and stored in a medication Pyxis station on each hospital floor. Respiratory therapists obtain patient medications from the Pyxis and proceed to the patient's room to administer the medication retrieved. Following administration, the metered dose inhaler (MDI) is returned to the Pyxis station. This process is repeated for each patient receiving respiratory medications. With the alternative "bedside strategy," therapists retrieve the patient's respiratory medication from the locked box at the bedside, administer the medication to the patient, and return the medication to the box, obviating the need to return medications to a central Pyxis. Travel time was calculated (using a stop watch to follow selected patients) as the interval between the therapist's arrival on the hospital floor and delivery of the medication to the individual patient or as the interval between completion of the prior patient's medication and delivery of medication to a subsequent patient.

ResultsTravel times were calculated for 12 patients treated with the "central strategy" and for 12 patients with the "bedside strategy." Mean therapist travel time was shorter using the bedside locked boxes (1.4 min/patient) compared with the Pyxis strategy (3.8 min/patient). Based on an average respiratory therapist salary of $46,176/year. (or $0.37/min), the bedside strategy was associated with a mean per patient savings of $0.89 per trip. Based on an average of 3 therapist trips (36,507 trips) to deliver 109,521 small volume nebulizer or MDI treatments during 2004, we estimate an overall cost savings of $32,491.23 using the "bedside approach".

ConclusionThese results show that use of a bedside medication locked box to store respiratory medications is associated with shortened respiratory therapist time to administer medications and a savings compared with a strategy in which respiratory medications are stored and retrieved from a central station on each ward. On this basis, we recommend the use of such locked boxes as a way to accelerate respiratory treatment while maintaining pharmacy review and compliance with current JCAHO regulations regarding medication dispensing.

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